Medicare and Medicaid can be confusing, to say the least. There are tons of mistakes that can be made throughout enrollment, understanding the requirements and guidelines for the payer(s), and record-keeping and audits. Where do you even start with knowing what mistakes to avoid? Let’s take a look at some of the most common errors.
1. Enrollment. Lack of attention to detail can derail your application.
Getting started off on the right foot with Medicare and Medicaid can be a difficult task. Therefore, it is important to be careful and observant throughout the application process, as a lack of detail-oriented work can result in application delays or even denial and could plant you firmly back at square one. Common mistakes include:
- Incomplete, incorrectly completed, or missing information
- Lack of follow-up on application status
- Failing to allow enough time for the entire application process to be completed
Be sure that you are paying attention throughout the enrollment processes, reviewing all information to make sure it’s accurate and following up with Medicare/Medicaid regularly to stay on top of it all. Taking extra time during each step to ensure you’re meeting all requirements will save you from many headaches later.
2. Implementing proper processes and regulations. (Not paying attention to requirements and needs set by Medicare/Medicaid and failing to set up trustworthy personnel and policies.)
A lack of understanding can lead to many roadblocks that slow your office down and get in the way of providing care. But how do you know what to do and not do?
The sure-fire way to stay out of troubled waters is by reviewing and understanding the Provider Handbooks from Medicare/Medicaid, which clearly state regulations and recommendations for remaining compliant under the payer(s). Staying up to date on the information in these handbooks and referring to it as needed to confirm you’re meeting requirements ensures smooth sailing.
However, simply knowing what the handbooks say can only go so far. You must also implement processes that support those regulations and allow your practice to remain compliant. For example, you must make sure your billing and claims are being properly handled, as mistakes in this area are considered fraud and can lead to penalties like fines, sanctions, and even criminal prosecution.
Errors in billing and claims can look like:
- Failing to hire competent and qualified personnel to handle billing and claims
- Incorrectly coding claims
- Not supporting claims with the necessary documentation, or referencing incorrect documentation when creating claims
- Failing to implement changes based on errors found in billing reviews
- Submitting claims for services or patients outside of Medicare/Medicaid coverage
Understanding, implementing, and updating policies and processes to reflect regulations set forth by Medicare and Medicaid is imperative to your success as a provider under those payers. Leaving holes in your practices may seem minor at the moment but can easily lead to more serious situations.
3. Record-Keeping and Audits. Everything from improper documentation to failing to comply with and follow through on billing/claims reviews and audits.
Records and Documentation
Perhaps one of the biggest areas for error is in records keeping, as it can cause a ripple effect of issues down the line. You must make sure that patient charts, billing, and claims are all updated and well-organized.
Falling behind or mixing up documents is the start of a domino effect: not updating patient charts to reflect all care and treatments, as well as billing and claims failing to match up with patient care documents and being submitted with inaccurate information, could at the very least lead to claims being denied. Failing to keep proper documentation can also lead to issues during any reviews or audits, as discussed below.
Audits and Conduct Within Them
The single state agencies will conduct audits as a regular practice, and in these, you must be willing and able to provide any and all requested information. Failure to do so could result in termination of your contract(s) with Medicare/Medicaid. This is where those records and documents come in. If you’ve kept up with your patient charts, billing, and claims documents, when the agency asks to take a look you’ll be able to oblige with confidence.
If all documents match up and each claim is substantiated, the audit becomes very easy. The more mistakes you have in your documents, the longer the audit will be, and the closer you will be to a possible penalty.
It is equally as important to keep a calm and information-gathering attitude during the audits. It is common for providers to attempt to argue results as they’re being found, which is a poor way to handle the situations.
These audits are not the times to contest and argue with the findings and doing so will likely only make things worse. Instead, try taking the stance of learning and note-taking, and gather all information and knowledge you can from the audit and its results. When the audit is completed, you can then implement any needed changes as soon as possible and properly prepare for contesting results as needed.
To summarize, what you must do to avoid these common Medicare and Medicaid mistakes is stay organized and pay attention. It’s all in the details, but now that you know where the common errors lie you can make sure your processes are reliable and airtight.
With trusted procedures, you’re able to maintain your standing as a compliant Medicare/Medicaid provider, which allows you to continue doing what you do best: treat and care for your patients.